Provider Demographics
NPI:1053497933
Name:ANDERSON, CHARLES HILL (LICSW)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:HILL
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:HILL
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:PO BOX 332
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:VT
Mailing Address - Zip Code:05055-0332
Mailing Address - Country:US
Mailing Address - Phone:802-649-2617
Mailing Address - Fax:
Practice Address - Street 1:289 MAIN ST.
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:VT
Practice Address - Zip Code:05055-0332
Practice Address - Country:US
Practice Address - Phone:802-649-2617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00001251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN1537Medicaid
VTANDE *080-5605OtherBLUE CROSS BLUE SHIELD
VTVN1537Medicare ID - Type Unspecified